5.7 non-malignant pain pt2 Flashcards
What are the uses of gabapentinoids (Gabapentin [Neurontin] and pregabalin [lyrica])?
- Fibromyalgia
- Neuropathies
- Post-operative pain
What are the available formulations of gabapentinoids?
- Tablet/capsule
- ER tablet
- Liquid solution
What is the recommended dosing of gabapentin (neurontin)?
- 100-300 mg PO TID
- Max 3600 mg/day
What is the recommended dosing of pregabalin (lyrica)?
- 75 mg PO BID
- Max 600 mg/day
What are the SEs of gabapentinoids?
Sedation, dizziness, peripheral edema
What are clinical pearls of gabapentinoids?
- Renally dose adjusted
- Titrate up dose to limit sedation
- Use in combo to decrease requirements of other analgesics
- Pregabalin is schedule V, gabapentin is unscheduled
What are the uses of SNRIs (venlafaxine [effexor], duloxetine [cymbalta])?
- Fibromyalgia
- Neuropathy
What are the available formulations of SNRIs?
- Capsule/tablet
- ER capsule/ER tablet
What is the recommended dosing of venlafaxine (effexor)?
- 37.5-75 mg PO daily
- Max 225 mg/day
What is the recommended dosing of duloxetine (cymbalta)?
- 30 mg PO daily x 1 week, then increase to 60 mg PO daily
- Max 60 mg/day
What are the SEs of SNRIs?
Nausea, headache, HTN, sedation, weakness
What are clinical pearls of SNRIs?
- Start low dose and titrate up to minimize SEs
- Renally dose adjust venlafaxine
When should duloxetine (cymbalta) be AVOIDED?
AVOID duloxetine for CrCl <30 ml/min
What are the uses of TCAs (amitriptyline [elavil], nortriptyline [pamelor])?
All off label:
- Fibromyalgia
- Neuropathy
- Migraine prophylaxis
What are the available formulations of TCAs?
- Tablet (amitriptyline)
- Capsule and oral solution (nortriptyline)
What is the recommended dosing for amitriptyline or nortriptyline?
- 10 mg PO QHS
- Max 150 mg/day
What are the SEs of TCAs?
- Anti-cholinergic SEs
- Sedation
When is TCAs used?
Last line option for neuropathy and fibromyalgia due to SEs
What drugs are muscle relaxants?
- Cyclobenzaprine (amrix, fexmid)
- Baclofen (lioresal)
- Methocarbamol (robaxin)
- Carisoprodol (soma)
- Tizanidine (zanaflex)
What is the use of muscle relaxants?
Musculo-skeletal pain/spasms
What are the available formulations of muscle relaxants?
- Tablet/capsule (IR/XR)
- Oral suspension (baclofen)
- Parenteral solution (methocarbamol, baclofen)
What is the recommended dosing of cyclobenzaprine?
- 5 mg PO TID
- Max 30 mg/day
What is the recommended dosing of baclofen?
- 5 mg PO TID
- Max 80 mg/day
What is the recommended dosing of carisoprodol?
- 250-350 mg PO TID
- Max 1050 mg/day
What is the recommended dosing of methocarbamol?
- 1.5 g PO 3-4x/day
- Max 8 g/day
What is the recommended dosing of tizanidine?
- 2-4 mg PO q8-12h
- Max 24 mg/day